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Do Old Errors Always Lead to New Truths? A Randomized Controlled Trial of Errorless Goal Management Training in Brain-Injured Patients

Published online by Cambridge University Press:  08 September 2015

Dirk Bertens ,
Roy P.C. Kessels ,
Eleonora Fiorenzato ,
Danielle H. E. Boelen  and
Luciano Fasotti
Dirk Bertens*
Affiliation:
Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
Roy P.C. Kessels
Affiliation:
Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
Eleonora Fiorenzato
Affiliation:
University of Padova, Department of General Psychology, Padova, Italy
Danielle H. E. Boelen
Affiliation:
Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands
Luciano Fasotti
Affiliation:
Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands
*
Correspondence and reprint requests to: Dirk Bertens, Montessorilaan 3, 6500 HE Nijmegen, The Netherlands. E-mail: d.bertens@donders.ru.nl
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Abstract

Both errorless learning (EL) and Goal Management Training (GMT) have been shown effective cognitive rehabilitation methods aimed at optimizing the performance on everyday skills after brain injury. We examine whether a combination of EL and GMT is superior to traditional GMT for training complex daily tasks in brain-injured patients with executive dysfunction. This was an assessor-blinded randomized controlled trial conducted in 67 patients with executive impairments due to brain injury of non-progressive nature (minimal post-onset time: 3 months), referred for outpatient rehabilitation. Individually selected everyday tasks were trained using 8 sessions of an experimental combination of EL and GMT or via conventional GMT, which follows a trial-and-error approach. Primary outcome measure was everyday task performance assessed after treatment compared to baseline. Goal attainment scaling, rated by both trainers and patients, was used as secondary outcome measure. EL-GMT improved everyday task performance significantly more than conventional GMT (adjusted difference 15.43, 95% confidence interval [CI] [4.52, 26.35]; Cohen’s d=0.74). Goal attainment, as scored by the trainers, was significantly higher after EL-GMT compared to conventional GMT (mean difference 7.34, 95% CI [2.99, 11.68]; Cohen’s d=0.87). The patients’ goal attainment scores did not differ between the two treatment arms (mean difference 3.51, 95% CI [−1.41, 8.44]). Our study is the first to show that preventing the occurrence of errors during executive strategy training enhances the acquisition of everyday activities. A combined EL-GMT intervention is a valuable contribution to cognitive rehabilitation in clinical practice. (JINS, 2015, 21, 639–649)

Keywords

RehabilitationChronic brain injuryLearningActivities of daily livingExecutive functionRandomized controlled trial
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 8 , September 2015 , pp. 639 - 649
Copyright
Copyright © The International Neuropsychological Society 2015 

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